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PCM III Exam 2 > Evaluation of the Peripheral Smear > Flashcards

Evaluation of the Peripheral Smear Flashcards

1
Q

Value of Peripheral Blood Smear Review

A

Inexpensive but a powerful diagnostic tool.
Provides information regarding bone marrow function and disorders.
Assists in assessment of anemias, white and red cell disorders, and thrombocytopenias.

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2
Q

How to Prepare a Peripheral Smear

A

“Wedge Technique”

Blood will go from thick to thin. View where the cells are a single layer and have a little “daylight”.

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3
Q

Red Cells

A

Size-
6-8μm diameter; 2-2μm thick

Shape-
Biconcave discs

Normal number-
4-6 x 106/μL

Color-
Area of central pallor surrounded by hemoglobin

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4
Q

Anisocytosis

A

Definition Anisocytosis: Considerable variation in the size of cells that are normally uniform, especially such a variation in red blood cells.

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5
Q

Some Causes of Anisocytosis

A 
Fe deficiency
Sideroblastic anemia
Vitamin A deficiency
Myelodysplastic syndrome
Hemoglobin H disease
Kwashiokor 
Folate deficiency
Vitamin B12 deficiency
Blood transfusion
Beta thalassaemia
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6
Q

Microcytosis

A 
Iron deficiency anemia
Thalassemia
Anemia of chronic disease
Sideroblastic anemias
Chronic lead exposure
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7
Q

Macrocytosis

A

Folate/B12 deficiency
Liver disease/ETOH
Primary bone marrow failure; myelodysplasia
Reticulocytosis (polychromasia)

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8
Q

Poikilocytosis

A

Variations in Red Cell Shape

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9
Q

Macroovalocytes

A

B12/folate deficiency (megaloblastic anemia)

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10
Q

Elliptocytes

A

hereditary

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11
Q

Fragmented erythrocytes (schistocytes)

A

TTP (Thrombotic thrombocytopenic purpura)
DIC (Disseminated intravascular coagulation )
HUS (Hemolytic uremic syndrome )
Defective heart valves
Hemolytic anemias

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12
Q

Acanthocyte

A

(Burr Cell) Red cells with irregularly spaced projections, variable in width with rounded ends. Seen in liver disorders.

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13
Q

Codocyte

A

(Target Cell) Red cells with central color spot in area of pallor; seen in Sickle cell, HbC & the thalassemias.

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14
Q

Dacrocyte

A

Teardrop shaped red cells Seen in myeloproliferative disorders, myelofibrosis, pernicious anemia and thalassemias.

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15
Q

Stomatocyte

A

Folded RBC mimicking a mouth and lips (slit-like appearance). Seen in hemolytic anemias, either constitutive or acquired

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16
Q

Sickle Cell Anemia

A

Marked Poikilocytosis and Anisocytosis

Sickle Cell Disease:
Two Classic Poikilocytes
Sickle cells
Target cells

Hemoglobinopathies

Sickledex Solubility Test for
SS trait and disease.

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17
Q

Beta-thalassemia blood smear

A

Marked poikilocytosis - abnormal shaped RBC’s) plus anisocytosis
with numerous microcytes.

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18
Q

Normochromic and Hypochromic”

A

Chromic: Greek chroma - color “Hypochromia”: reduction in color intensity for an object from its normal state

Hypochromia on peripheral smear indicates increased central pallor of RBCs

Normochromic: RBCs contain normal hemoglobin concentration & stain with normal red intensity on peripheral smear with a Romanowsky stain

Hypochromic indicates the red cells contain a decreased concentration of hemoglobin. Red cells exhibit an increased area of central pallor.

No “Hyperchromia”. Can only cram 270 million hemoglobin molecules into red cell.

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19
Q

Variations in Red Cell Color (Chromia)

A

Central pallor should be approximately 1/3 of the cell

Increased central pallor (hypochromic)

  • Thalassemia
  • Iron deficiency anemia
  • Sideroblastic anemia

Decreased central pallor
- Hereditary spherocytosis
- Autoimmune hemolytic
anemia

20
Q

Hypochromic Microcytic

A

Hypochromic microcytic anemia of iron deficiency. Note small red cells containing a narrow rim of peripheral hemoglobin. Scattered fully hemoglobinized cells are present due to recent blood transfusion and stand in contrast to the “empty” hypochromic microcytic red cells.

21
Q

Rouleaux

A

“stack of coins”
Multiple myeloma
Due to elevated plasma
fibrinogen or globulins

22
Q

Clumping

A

Cold agglutinins

23
Q

Immature Red Cells (Nucleated Red Cells, Normoblasts)

A

Nucleated red cells (normoblasts): immature red cell progenitors not normally present in blood. Normoblast size is 7 to 12 µm in diameter with a pink cytoplasm (Hgb). The nucleus is pyknotic (a homogeneous blue-black mass with no structure).

24
Q

Indicators of Increased Hematopoiesis/Stressed Bone Marrow

A

Increased hematopoiesis:
Reticulocytes
Nucleated RBCs
(Normoblasts)

25
Q

Inclusions

A

Basophilic stippling: round, dark-blue granules in reticulocytes on smears stained with supra vital stains (brilliant cresyl blue).

The granules are precipitated ribosomes and mitochondria. Classic finding in lead poisoning.

Howell-Jolly bodies: Spherical blue-black red cell inclusions seen on Wright-stained smears.

They are nuclear fragments of condensed DNA, 1-2 µm diameter, normally removed by the spleen. Seen in severe hemolytic anemias and in post-splenectomy patients (below).

26
Q

White Cells

A

Part of a complete blood count (CBC) is a differential
- It “differentiates” the 5 main types of WBCs by assigning a percentage of each type after counting 100 WBCs on the peripheral smear
- There is a reference range (% of total WBC) for each type
-
** Absolute (Neutrophil)count = % x Total WBC

27
Q

Neutrophils

A 
50-60%
Elevated in bacterial infections, stress, corticosteroid therapy
Immature forms 
   often present with 
   elevated count
28
Q

Lymphocytes

A

30-40% of circulating WBCs
Elevated in viral infections (Epstein-Barr, etc.)
“atypical” lymphocytes (mono)
Fragile lymphocytes (smudge or basket cells) are common in chronic lymphocytic leukemia (CLL)
Large nucleus to cytoplasm

29
Q

Eosinophils

A

< 5%
Elevated in parasitic infections,
allergies

30
Q

Basophils

A

< 1%
Elevated in chronic
myelogenous leukemia (CML)
Large granules

31
Q

Left shift

A

increase in immature forms in peripheral blood due to increased production:
Infections, myeloid cancers

32
Q

Dohle bodies:

A

Seen in systemic infectious or inflammatory disease

Often accompanied by a left shift, toxic granulation and cytoplasmic vacuoles

33
Q

Hypersegmented Neutrophils

A

> 5 lobes
Can be seen in megaloblastic anemias
B12 and folate deficiency

34
Q

Reduced lobulation of mature neutrophils

A

Pelger-Huet anomaly

Often associated with myelodysplastic syndromes

35
Q

Other Abnormal WBC Findings: Blasts

A

may indicate WBC neoplasia (myeloid or lymphoid leukemias)

36
Q

Other Abnormal WBC Findings: Plasma cells-

A

may indicate lymphoid neoplasia (e.g., multiple myeloma)

37
Q

Normal platelet count:

A

150,000-450,000/μL

under 25,000 – spontaneous bleeding
>1,000,000 – spontaneous clotting
1 unit of platelets = increase of 5,000. Never give 1 unit, 5 or more.

38
Q

Giant platelets

A

Suggest marrow response secondary to increased platelet destruction or consumption

  • Congenital disorders
  • Immune destruction
  • Disseminated intravascular coagulation (DIC)
  • Hemolytic uremic syndrome (HUS)
  • Thrombotic thrombocytopenic purpura (TTP)
39
Q

Clinical manifestations of thrombocytopenia or dysfunctional platelets-

A

Petechiae

Purpura

40
Q

Lymphadenopathy

A

Lymphadenopathy: Painless enlargement of a lymph node or group of nodes

Applies to any enlargement of lymph node(s)
Infection most likely cause of lymphadenopathy, particularly in children
- Viral infection most likely cause of lymphadenopathy

Supraclavicular and axillary lymph node enlargement is more concerning

Lymph node > 4 centimeters most likely is malignant

41
Q

Lymphadenitis

A

Acute Nonspecific Lymphadenitis: Swollen, edematous tender** (painful) with distended capsule

42
Q

Chronic Nonspecific Lymphadenitis

A

Enlarged but painless; capsule is proportionally enlarged. Nodes are palpable (> 2cm).

43
Q

Chronic Nonspecific Lymphadenitis Exhibits three patterns

A

Stimulate B-cell populations: Follicular Hyperplasia (rheumatoid arthritis, toxoplasmosis, early stages HIV)

Stimulate T-cell populations: Paracortical Hyperplasia (infectious mono, acute viral infections, following vaccinations, reactions to Dilantin.)

Stimulate macrophages: Sinus Histiocytosis (e.g. in axillary nodes draining a region of breast cancer.)

44
Q

Reactive Hyperplasia

Manifestations of immune response

A

B cell transformation/proliferation –
Follicular hyperplasia of CD 20+ B-cells in follicles (3)

T cell transformation/proliferation –
Diffuse interfollicular hyperplasia of CD3+ T-cells in paracortex (6)

Histiocyte recruitment/activation –
Subcapsular and paracortical sinus histiocytosis (2&6)

45
Q

Cat Scratch Disease

A
  • *Initially, sarcoid-like granulomas
  • *Later stellate necrotizing granulomas

(Self-limited lymphadenitis usually of head and neck
Bartonella henselae
Cat scratch, splinter or thorn
Primarily in children
Rarely encephalitis, osteomyelitis, or thrombocytopenia)

PCM III Exam 2 (9 decks)

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